Avatar-based patient monitoring improves information transfer, diagnostic confidence and reduces perceived workload in intensive care units: computer-based, multicentre comparison study

Abstract

Patient monitoring is the foundation of intensive care medicine. High workload and information overload can impair situation awareness of staff, thus leading to loss of important information about patients’ conditions. To facilitate mental processing of patient monitoring data, we developed the Visual-Patient-avatar Intensive Care Unit (ICU), a virtual patient model animated from vital signs and patient installation data. It incorporates user-centred design principles to foster situation awareness. This study investigated the avatar’s effects on information transfer measured by performance, diagnostic confidence and perceived workload. This computer-based study compared Visual-Patient-avatar ICU and conventional monitor modality for the first time. We recruited 25 nurses and 25 physicians from five centres. The participants completed an equal number of scenarios in both modalities. Information transfer, as the primary outcome, was defined as correctly assessing vital signs and installations. Secondary outcomes included diagnostic confidence and perceived workload. For analysis, we used mixed models and matched odds ratios. Comparing 250 within-subject cases revealed that Visual-Patient-avatar ICU led to a higher rate of correctly assessed vital signs and installations [rate ratio (RR) 1.25; 95% CI 1.19–1.31; P < 0.001], strengthened diagnostic confidence [odds ratio (OR) 3.32; 95% CI 2.15–5.11, P < 0.001] and lowered perceived workload (coefficient − 7.62; 95% CI − 9.17 to − 6.07; P < 0.001) than conventional modality. Using Visual-Patient-avatar ICU, participants retrieved more information with higher diagnostic confidence and lower perceived workload compared to the current industry standard monitor.

User Perceptions of Avatar-Based Patient Monitoring for Intensive Care Units: An International Exploratory Sequential Mixed-Methods Study

“…The online survey was conducted between July and October 2021. In this study, we included the same 50 participants who were part of a previous computer-based study that compared two different patient monitoring modalities (Visual Patient Avatar ICU versus conventional monitor) [19].…”

“…In the previous computer-based study, a total of 50 participants, consisting of five ICU nurses and five physicians at each of the five study sites, engaged with five distinct patient scenarios [19]. These scenarios were presented twice, once as Visual Patient Avatar ICU and once as the conventional modality, resulting in a total of ten cases per participant.…”

“…These scenarios were presented twice, once as Visual Patient Avatar ICU and once as the conventional modality, resulting in a total of ten cases per participant. This study aimed to examine the impact of Visual Patient Avatar ICU on information transfer, which was assessed by accuracy in evaluating vital signs and installations [19]. Subsequent to the completion of all cases, structured interviews were conducted as an integral component of this mixed-methods study.…”

“…This approach enables a more efficient perception of vital signs [10,16] and increases the likelihood of verbalizing the cause of the emergencies [17] compared to conventional monitoring. Furthermore, computer-based studies showed that Phillips Visual Patient Avatar significantly improves diagnostic confidence among anesthetists and reduces workload compared to standard monitoring [10,[16][17][18][19].…”

“…An extended version of Visual Patient Avatar, called Visual Patient Avatar ICU, is currently being developed and investigated. Visual Patient Avatar ICU can additionally display patient-inserted devices such as arterial, central lines, and urinary catheters along with their respective insertion locations (Figure 1) [19]. A previous computer-based study has demonstrated that the Visual Patient Avatar ICU improves information transfer, enhances diagnostic confidence, and reduces the perceived workload of ICU staff compared to conventional monitor modalities [19].…”